Billing and reimbursement don’t have to be painful. Clover RCM delivers world-class service, maximizes reimbursements, and delivers actionable insights into the financial health of your practice.

Benefits of RCM Automation

RCM is essentially an internal process which healthcare providers prefer managing on their own, largely due to the sensitive nature of data. However, there are several revenue cycle management software solutions and products available in the market, that allow providers to automate their RCM process.

For practices with thousands of practitioners and multiple operating locations, RCM automation becomes a necessity otherwise the administrative load can become crippling and regressive for the organization. Many even prefer outsourcing the process to achieve efficiency and better financial success.

RCM automation, internal or outsourced, essentially helps providers dedicate their focus back on patient care and allow trained professionals to handle revenue management. Critical areas that benefit from RCM automation are operational costs management, resource allocation, data compliance, authorization, regulations, billing, and payor contract management.

Ultimately, with automated RCM, the practice gets paid to its fullest potential – be it from the patients or payors.

The process of getting a provider credentialed with a payer involves too many manual steps such as completing application forms, providing clarifications to questions from payers and following up with them to close the credentialing request. With CGS you can keep your data up-to-date with payers by using our Provider Credentialing Services.

Medical Coding

Our medical coding team is seasoned and expert in ICD-10, CPT & HCPCS Coding across multiple Coding specialties and undergoes rigorous Continual Education on the latest updates.

Our Service Quality Procedure follows a strong 11 steps process for accurate & in-depth analysis with various audit methodologies as per Client requirements. Knowledge Enhancement training sessions followed by periodic evaluations to gauge both Coders & auditors were carried out and shared with Clients. We work towards our common goal of providing services “to the delight of our Customers”.

Patient Demographics

Patient demographics include identifying information such as name, date of birth and address, along with insurance information. Patient demographics streamline the medical billing process, improve healthcare quality, enhance communication and bolster cultural competency. Getting complete and accurate information from patients at the point-of-service, and accurately capturing the information in your revenue cycle system is not only essential to the success of your revenue cycle but also enables multivariate population health analytics.

Eligibility

Insurance Verification becomes the most crucial part of the RCM cycle as it could avoid denials relating to COB which affect the reimbursement within the 30 to 60 cycle. Our dedicated team uses internally developed applications and if require physical calling to determine the eligibility of the patient avoiding rejections and denials forefront.

 Charge Posting

We do charge entry as a part of the healthcare revenue cycle management services. Since we have prior experience in handling different renowned medical billing software and several medical specialties, we start with the process directly, saving staff training time and effort. We pre-define account specific rules in charge entry for different medical specialties which reduces the room for errors and contributes to clean claims.

Payment Posting

Here CGS, payments received from patients & insurance companies are posted to the patients accounts in the client’s medical billing system. The posted payments are balanced against the deposit slips to ensure accuracy in payment. The payment posters also check for any under payment being made to the accounts. We also do electronic posting of payments in to the medical billing software and ensure that the EOB files are stored for future references.

Accounts Receivable

Reduce your unpaid debt and collect more money at the same time by leveraging time-tested best practices and a proven process to collect payments and reduce backlogs in AR. The result: more money collected faster. Satisfaction is the minimum, but delight is the goal. Improve your revenue cycle process end-to-end, by identifying the reasons for the AR backlogs, not just treating the symptoms. Go above and beyond, and stop the problem before it starts.

 Denial Management

We work hard to reduce the damaging effects, denied claims have on your organization. Our mission is to help you collect money faster and increase revenues every month.

Our denial management services employ a combination of human expertise and technological tools to scrub claims at the front end.